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DRY EYE DX AND TX

SARS-COV-2 AND EYE CARE

Life as we know it has been grinding to a halt due to the highly contagious and novel coronavirus, SARS-CoV-2, which, at the time of this writing in late March, is spreading like wildfire throughout the world. “Novel” simply refers to a viral strain that we’ve never seen before; unfortunately, because it is completely new, there is no known treatment, cure, or preventative vaccine, which makes it all the more anxiety-provoking.

COVID-19 and Conjunctivitis

There is a rising concern among eyecare practitioners (especially on social media) of SARS-CoV-2 presenting with conjunctivitis and the possibility of viral transmission through infected conjunctivae or tears. Fortunately, the association of conjunctivitis with SARS-CoV-2 doesn’t appear to be very common. The China Medical Treatment Expert Group for Covid-19 recently published a paper documenting the clinical signs and symptoms of 1,099 patients hospitalized with confirmed COVID-19 (the severe respiratory disease that can be caused by the virus) from 552 hospitals in mainland China through Jan. 28, 2020 (Guan et al, 2020). Only nine patients (0.8%) had signs of “conjunctival injection.”

Another study group analyzed a similar, but much smaller, patient cohort at the First Affiliated Hospital of Zhejiang University from Jan. 26, 2020 through Feb. 9, 2020. They found only one case of conjunctivitis in 30 COVID-19-confirmed patients (3%) (Xia et al, 2020). SARS-CoV-2 virus was recovered from ocular secretions of that patient only.

These studies together at least suggest that SARS-CoV-2 conjunctivitis is a rare finding and that the virus may be present only in the tears of patients who have active conjunctivitis; although clearly, more studies need to be done.

Protecting Yourself

Although contracting SARS-CoV-2 through infected tears is certainly a possibility, there are more likely routes for viral transmission, including the inhalation of suspended droplets from the coughs and sneezes of others (aerosol transmission) as well as through direct contact—touching contaminated surfaces and then transferring the virus to your own mouth, nose, eyes, and other mucous membranes. Van Doremalen et al (2020) recently determined that SARS-CoV-2 can be detected for up to two to three days on plastic and stainless steel surfaces.

Due to the close working distance that eyecare providers must maintain with patients to conduct exams, it is important to take extra precautions to protect against these routes of transmission by using eye or face shields or goggles, washing hands frequently, and using gloves when caring for patients who are potentially infected. The Centers for Disease Control and Prevention (CDC) recommends frequent disinfection of commonly touched surfaces using cleaners with Environmental Protection Agency-approved emerging viral pathogens claims or alcohol solutions/wipes containing at least 70% alcohol (CDC, 2020).

Prepare for Lasting Changes

Without a doubt, this new virus will have a substantial impact on those working in the ophthalmic community as well as on the many people whom they serve. Multiple organizations have urged practitioners to postpone all non-urgent care, especially for elderly patients and those who have comorbidities. Many offices have temporarily closed their doors, and philanthropic medical missions have been put on hold. It’s possible that this virus could ultimately lead to increased vision loss worldwide, not because of direct consequences of SARS-CoV-2 eye infection, but because of trickle-down effects on susceptible populations.

That said, setbacks and challenges are the basic building blocks of ingenuity. I have little doubt that we will also see positive changes (think telehealth) in the overall profession of eye care on the other side of the SARS-CoV-2 pandemic. CLS

For references, please visit www.clspectrum.com/references and click on document #294.